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OBJECTIVES: To document the effects of compulsory mouthguard wearing on rugby related dental injury claims made to ACC, the administrator of New Zealand's accident compensation scheme. METHODS: An ecological study was conducted. Estimates of mouthguard wearing rates were available from prospective studies conducted in 1993, 2002, and 2003. Rugby related dental injury claims were available for the period 1995-2003. Player numbers were available from 1998. Mouthguard wearing was made compulsory during match play for rugby players at under 19 level and below at the beginning of the 1997 season, and for all grades of domestic rugby at the beginning of the 1998 season. Greater powers of enforcement were provided to referees at the beginning of the 2003 season. RESULTS: The self reported rate of mouthguard use was 67% of player-weeks in 1993 and 93% in 2003. A total of 2644 claims was reported in 1995. There was a 43% (90% confidence interval 39% to 46%) reduction in dental claims from 1995 to 2003. On the reasonable assumption that the number of players and player-matches remained constant throughout the study period, the relative rate of injury claims for non-wearers versus wearers was 4.6 (90% confidence interval 3.8 to 5.6). The cumulative savings in claim costs compared with the cost per year if claim numbers had remained constant from 1995 is 1.87 million NZD. CONCLUSION: Although ecological studies have acknowledged weaknesses, the findings provide evidence that mouthguard use is a simple and effective injury prevention strategy for rugby players. The use of mouthguards for all players in both matches and contact practice situations is strongly recommended. [ABSTRACT FROM AUTHOR]

Objectives: Although the nature of rugby injury has been well documented, little is known about key risk factors. A prospective cohort study was undertaken to examine the association between potential risk factors and injury risk, measured both as an injury incidence rate and as a proportion of the playing season missed. The latter measure incorporates a measure of injury severity.Methods: A cohort of 258 male players (mean (SD) age 20.6 (3.7) years) were followed through a full competitive season. At a preseason assessment, basic characteristics, health and lifestyle patterns, playing experience, injury experience, training patterns, and anthropometric characteristics were recorded, and then a battery of fitness tests were carried out.Results: A multiple regression model identified grade and previous injury experience as risk factors for in season injury, measured as an injury incidence rate. A second model identified previous injury experience, hours of strenuous physical activity a week, playing position, cigarette smoking status, body mass index, years of rugby participation, stress, aerobic and anaerobic performance, and number of push ups as risk factors for in season injury, measured as proportion of season missed.Conclusions: The findings emphasise the importance of previous injury as a predictor of injury incidence and of missing play. They also show the importance of considering both the incidence rate and severity of injury when identifying risk factors for injury in sport. [ABSTRACT FROM AUTHOR]

Determining whether repetitive head impacts (RHI) cause the development of chronic traumatic encephalopathy (CTE)-neuropathological change (NC) and whether pathological changes cause clinical syndromes are topics of considerable interest to the global sports medicine community. In 2022, an article was published that used the Bradford Hill criteria to evaluate the claim that RHI cause CTE. The publication garnered international media attention and has since been promoted as definitive proof that causality has been established. Our counterpoint presents an appraisal of the published article in terms of the claims made and the scientific literature used in developing those claims. We conclude that the evidence provided does not justify the causal claims. We discuss how causes are conceptualised in modern epidemiology and highlight shortcomings in the current definitions and measurement of exposures (RHI) and outcomes (CTE). We address the Bradford Hill arguments that are used as evidence in the original review and conclude that assertions of causality having been established are premature. Members of the scientific community must be cautious of making causal claims until the proposed exposures and outcomes are well defined and consistently measured, and findings from appropriately designed studies have been published. Evaluating and reflecting on the quality of research is a crucial step in providing accurate evidence-based information to the public., (© 2024. The Author(s).)

Background: There is limited research on associations between playing rugby union and player health post-retirement., Objective: This study investigated differences in self-reported sport injury history and current self-reported health characteristics between former New Zealand rugby and non-contact sport players with a view to identifying issues to be further investigated with stronger epidemiological research designs., Methods: Using a cross-sectional design, the NZ-RugbyHealth study surveyed 470 former rugby and non-contact sport players (43.8 ± 8.1 years; 127 elite rugby, 271 community rugby, 72 non-contact sport) recruited from October 2012 to April 2014. Demographic information, engagement in sport, sport injuries, medical conditions, mood, alcohol and substance use and ratings of current health status were obtained from a self-report 58-item general health e-questionnaire. We highlighted standardised differences in means of > 0.6 and differences in relative percentages of > 1.43 for variables between groups as representing at least moderate effect sizes, and of being worthy of follow-up studies., Results: Higher percentages of the elite rugby player group had sustained injuries of a given body-site type (e.g. neck sprain/strain, thigh bruising, hamstring strain) combination than the non-contact sports players. Higher percentages of the rugby groups reported having sustained concussion (94% for elite, 82% for community, 26% for non-contact), injuries requiring hospitalisation (73%, 46%, 25%), injuries that stopped participation in sport permanently (28%, 28%, 11%) and sport-related surgery (72%, 46%, 32%) during their playing career. Both rugby groups had a higher prevalence of osteoarthritis (37%, 18%, 6%) than non-contact athletes and community rugby players had higher levels of hazardous alcohol consumption (38%, 40%, 25%) in retirement than non-contact athletes. There was little difference between rugby players and non-contact sports athletes in self-reported mood, substance use and current physical or psychological health ratings., Conclusions: Former rugby player groups were at higher risk than the non-contact player group for most injuries during their playing careers, and in retirement had greater prevalence of osteoarthritis and hazardous alcohol consumption. The relative youth of the groups (43.8 years on average) means that health issues that typically do not emerge until later life may not have yet manifested., (© 2022. The Author(s).)

Injury surveillance systems seek to describe injury risk for a given sport, in order to inform preventative strategies. This often leads to comparisons between studies, although these inferences may be inappropriate, considering the range of methods adopted. This study aimed to describe the injury epidemiology of seven youth sports, enabling valid comparisons of injury risk. Consistent methods were employed across seven sports [male American football, basketball, soccer, rugby league, rugby union; female soccer and rugby union] at a high school in England. A 24-hour time-loss injury definition was adopted. Descriptive statistics and injury incidence (/1000 match-hours) are reported. In total, 322 injuries were sustained by 240 athletes (mean age=17.7±1.0) in 10 273 player-match hours. American football had a significantly greater injury incidence (86/1000 h; 95% CI 61-120) than all sports except female rugby union (54/1000 h; 95% CI 37-76). Concussion was the most common injury (incidence range 0.0-26.7/1000 h), while 59% of injuries occurred via player contact. This study employed standardized data collection methods, allowing valid and reliable comparisons of injury risk between youth sports. This is the first known study to provide epidemiological data for female rugby union, male basketball and American football in an English youth population, enabling the development of preventative strategies., Competing Interests: CB is the medical lead for the institute where this data was collected. KAS is employed by the Rugby Football Union, the governing body for rugby in the UK. KAS is the editor at the International Journal of Sports Medicine., (Thieme. All rights reserved.)

Traumatic brain injury (TBI) accounts for significant global health burden. Effects of TBI can become chronic even following mild injury. There is a need to develop effective therapies to attenuate the damaging effects of TBI and improve recovery outcomes. This literature review using a priori criteria (PROSPERO; CRD42018100623) summarized 43 studies between January 1998 and July 2019 that investigated nutritional interventions (NUT) delivered with the objective of altering neurophysiological (NP) outcomes following TBI. Risk of bias was assessed for included studies, and NP outcomes recorded. The systematic search resulted in 43 of 3,748 identified studies met inclusion criteria. No studies evaluated the effect of a NUT on NP outcomes of TBI in humans. Biomarkers of morphological changes and apoptosis, oxidative stress, and plasticity, neurogenesis, and neurotransmission were the most evaluated NP outcomes across the 43 studies that used 2,897 animals. The risk of bias was unclear in all reviewed studies due to poorly detailed methodology sections. Taking these limitations into account, anti-oxidants, branched chain amino acids, and ω-3 polyunsaturated fatty acids have shown the most promising pre-clinical results for altering NP outcomes following TBI. Refinement of pre-clinical methodologies used to evaluate effects of interventions on secondary damage of TBI would improve the likelihood of translation to clinical populations., (© 2020 Wiley Periodicals LLC.)

Objectives: To identify which aspects of initial clinical assessment for sport-related mild traumatic brain injury (SR-mTBI) predict whether an athlete achieves symptom resolution within 14 days of the injury., Research Design: Retrospective cohort study using prospectively collected data., Methods: Clinical assessment data were collected from 568 patients diagnosed with SR-mTBI at a single medical clinic between February 2017 and December 2018. Demographic data, medical history, SCAT-5 testing, and physician notes were included in the data set. Data were processed and analysed to identify a shortlist of predictor variables to develop a logistic regression model to discriminate between SR-mTBI symptom resolution that occurred in ≤ 14-days or > 14-days. The data were randomly divided into model development and validation subsamples. The top 15 models were analysed to determine the predictor variables to be included in the final logistic regression model. The final model was then applied to the validation subsample., Results: Half of the athlete participants in this study experienced > 14-day symptom resolution. The final logistic regression model included sex, symptom reporting at initial assessment and presentation with a physiological predominant symptom cluster. The model accounted for 0.90 and 0.85 of the area under the curve and predicted recovery trajectory with 81% and 76% accuracy for the training and validation subsamples, respectively., Conclusions: Being female, reporting a higher Positive Symptom Total at initial assessment, and being less likely to have a physiological predominant symptom cluster at initial assessment predicted > 14 versus ≤ 14-day SR-mTBI symptom resolution with a high level of accuracy.

Using an expert consensus-based approach, a rugby union Video Analysis Consensus (RUVAC) group was formed to develop a framework for video analysis research in rugby union. The aim of the framework is to improve the consistency of video analysis work in rugby union and help enhance the overall quality of future research in the sport. To reach consensus, a systematic review and Delphi method study design was used. After a systematic search of the literature, 17 articles were used to develop the final framework that described and defined key actions and events in rugby union (rugby). Thereafter, a group of researchers and practitioners with experience and expertise in rugby video analysis formed the RUVAC group. Each member of the group examined the framework of descriptors and definitions and rated their level of agreement on a 5-point agreement Likert scale (1: strongly disagree ; 2: disagree ; 3: neither agree or disagree ; 4: agree ; 5 : strongly agree ). The mean rating of agreement on the five-point scale (1: strongly disagree ; 5: strongly agree ) was 4.6 (4.3-4.9), 4.6 (4.4-4.9), 4.7 (4.5-4.9), 4.8 (4.6-5.0) and 4.8 (4.6-5.0) for the tackle, ruck, scrum, line-out and maul, respectively. The RUVAC group recommends using this consensus as the starting framework when conducting rugby video analysis research. Which variables to use (if not all) depends on the objectives of the study. Furthermore, the intention of this consensus is to help integrate video data with other data (eg, injury surveillance)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting., Competing Interests: Competing interests: BR receives payment for duties as Editor-in-Chief of the The Orthopaedic Journal of Sports Medicine. KK is the Editor-in-Chief of the British Journal of Sports Medicine., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport- or setting-specific consensus statements on sports injury (and, eventually, illnesses) epidemiology to date., Objective: To further strengthen consistency in data collection, injury definitions, and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension., Study Design: Consensus statement of the International Olympic Committee (IOC)., Methods: The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups, and a 3-day consensus meeting in October 2019., Results: This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems, severity of health problems, capturing and reporting athlete exposure, expressing risk, burden of health problems, study population characteristics, and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS)., Conclusion: The IOC encourages ongoing in- and out-of-competition surveillance programs and studies to describe injury and illness trends and patterns, understand their causes, and develop measures to protect the health of the athlete. The implementation of the methods outlined in this statement will advance consistency in data collection and research reporting., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.R. receives payment for duties as Editor-in-Chief of The Orthopaedic Journal of Sports Medicine. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Synopsis: Sport-related concussion is common in full-contact and collision sports. Epidemiology studies use different types of surveillance systems and concussion definitions. Concussion incidence rates vary across age, sex, sport, and level of competition. Incidence rates are increasing, likely due to higher rates of reporting following improved knowledge and increased regulations. In this review, we summarize 7 key concepts related to concussion epidemiology: concussion definition, changes in concussion knowledge, reliability and accuracy of injury surveillance systems, conservative management and return to play, reliability of self-report, incidence of concussion across levels of play, and understanding the behaviors of players, coaches, and medical personnel from a multidisciplinary management perspective. J Orthop Sports Phys Ther 2019;49(11):768-778. doi:10.2519/jospt.2019.9105 .

A clash of values has been identified between those who assert that:1. all childhood injuries, regardless of origin, are inherently undesirable and should be prevented and;2. those who believe that some measure of injury to children is an acceptable compromise for the physical benefits associated with physical activity and the development of abilities to appraise and deal with risks.A debate regarding whether the tackles and collisions permitted in schools' rugby represent acceptable risks, and what steps should be taken if they do not, exemplifies the issue.Questions regarding the magnitude of injury risks in sport are issues of fact and can be quantified via the results of injury surveillance studies. Risks are neither high nor low in isolation; they are relatively high or low with reference to other activities or across groups participating in an activity. Issues of the acceptability of a given degree of risk are value dependent. Research regarding perceptions of risk reveals wide variations in the degree of risk people view as acceptable. Factors impacting on risk perception include whether the risks are well known and understood, whether they are 'dread' risks and the degree to which people undertake the risks voluntarily and feel they have control over them.Based on the evidence currently available, the risks to children playing rugby do not appear to be inordinately high compared with those in a range of other childhood sports and activities, but better comparative information is urgently needed. Further evidence, however, should not necessarily be expected to result in the resolution of acceptable risk debates-pre-existing values shape our perspectives on whether new evidence is relevant, valid and reliable., Competing Interests: Competing interests: Dr Ken Quarrie is employed by New Zealand Rugby, in the role of Senior Scientist; is a member of World Rugby’s Medical, Science and Research Working Group, a member of World Rugby’s Scientific Committee, and a member of World Rugby’s Scrum Steering Group. He is aware of, and complies with, the professional standards expected of scientists as stated in the Royal Society of New Zealand’s Code of Professional Standards in Ethics in Science, Technology and the Humanities. Professor Patria Hume specialises in sports injury prevention research, specifically sports injury biomechanics, sports injury epidemiology and sports kinanthropometry. She is aware of, and complies with, the professional standards expected of scientists stated in the Royal Society of New Zealand’s Code of Professional Standards in Ethics in Science, Technology and the Humanities. She was commissioned by World Rugby and New Zealand Rugby to lead the WR/NZR/AUT Rugby Health study in New Zealand, for which AUT received financial contribution towards her salary and other co-researchers’ salaries and study costs. Professor Hume was a co-supervisor for Ken Quarrie’s PhD. Nicholas Burger is a doctoral student at the University of Cape Town (UCT) specialising in the field of tackle-related injury epidemiology and tackle performance in youth rugby union players. He has previously worked as a researcher for the South African Rugby Union (SA Rugby) and the BokSmart National Rugby Safety Programme, and was granted access to the SA Rugby injury and video databases for use in his thesis. He attests that his research is in accordance with the guidelines and SOPs established by the UCT Human Research Ethics Committee and all his studies have received ethical approval. Dr John Brooks was formerly employed by the Rugby Football Union as a researcher examining the epidemiology of rugby among professional players in the United Kingdom. He is currently practising medicine. Dr Steve Jackson has no relevant conflicts of interest., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Aim: This study investigated differences in cognitive function between former rugby and non-contact-sport players, and assessed the association between concussion history and cognitive function., Methods: Overall, 366 former players (mean ± standard deviation [SD] age 43.3 ± 8.2 years) were recruited from October 2012 to April 2014. Engagement in sport, general health, sports injuries and concussion history, and demographic information were obtained from an online self-report questionnaire. Cognitive functioning was assessed using the online CNS Vital Signs neuropsychological test battery. Cohen's d effect size statistics were calculated for comparisons across player groups, concussion groups (one or more self-reported concussions versus no concussions) and between those groups with CNS Vital Signs age-matched norms (US norms). Individual differences within groups were represented as SDs., Results: The elite-rugby group (n = 103) performed worse on tests of complex attention, processing speed, executive functioning, and cognitive flexibility than the non-contact-sport group (n = 65), and worse than the community-rugby group (n = 193) on complex attention. The community-rugby group performed worse than the non-contact group on executive functioning and cognitive flexibility. Compared with US norms, all three former player groups performed worse on verbal memory and reaction time; rugby groups performed worse on processing speed, cognitive flexibility and executive functioning; and the community-rugby group performed worse on composite memory. The community-rugby group and non-contact-sport group performed slightly better than US norms on complex attention, as did the elite-rugby group for motor speed. All three player groups had greater individual differences than US norms on composite memory, verbal memory and reaction time. The elite-rugby group had greater individual differences on processing speed and complex attention, and the community-rugby group had greater individual differences on psychomotor speed and motor speed. The average number of concussions recalled per player was greater for elite rugby and community rugby than non-contact sport. Former players who recalled one or more concussions (elite rugby, 85 %; community rugby, 77 %; non-contact sport, 23 %) had worse scores on cognitive flexibility, executive functioning, and complex attention than players who did not recall experiencing a concussion., Conclusions: Past participation in rugby or a history of concussion were associated with small to moderate neurocognitive deficits (as indicated by worse CNS Vital Signs scores) in athletes post retirement from competitive sport.

Background: The loads to which professional rugby players are subjected has been identified as a concern by coaches, players and administrators. In November 2014, World Rugby commissioned an expert group to identify the physical demands and non-physical load issues associated with participation in professional rugby., Objective: To describe the current state of knowledge about the loads encountered by professional rugby players and the implications for their physical and mental health., Findings: The group defined 'load' as it relates to professional rugby players as the total stressors and demands applied to the players. In the 2013-2014 seasons, 40% of professional players appeared in 20 matches or more, and 5% of players appeared in 30 matches or more. Matches account for ∼5-11% of exposure to rugby-related activities (matches, team and individual training sessions) during professional competitions. The match injury rate is about 27 times higher than that in training. The working group surmised that players entering a new level of play, players with unresolved previous injuries, players who are relatively older and players who are subjected to rapid increases in load are probably at increased risk of injury. A mix of 'objective' and 'subjective' measures in conjunction with effective communication among team staff and between staff and players was held to be the best approach to monitoring and managing player loads. While comprehensive monitoring holds promise for individually addressing player loads, it brings with it ethical and legal responsibilities that rugby organisations need to address to ensure that players' personal information is adequately protected., Conclusions: Administrators, broadcasters, team owners, team staff and the players themselves have important roles in balancing the desire to have the 'best players' on the field with the ongoing health of players. In contrast, the coaching, fitness and medical staff exert significant control over the activities, duration and intensity of training sessions. If load is a major risk factor for injury, then managing training loads should be an important element in enabling players to perform in a fit state as often as possible., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objectives: Goal kicking is an important element in rugby but has been the subject of minimal research. To develop and apply a method to describe the on-field pattern of goal-kicking and rank the goal kicking performance of players in international rugby union matches., Design: Longitudinal observational study., Methods: A generalized linear mixed model was used to analyze goal-kicking performance in a sample of 582 international rugby matches played from 2002 to 2011. The model adjusted for kick distance, kick angle, a rating of the importance of each kick, and venue-related conditions., Results: Overall, 72% of the 6769 kick attempts were successful. Forty-five percent of points scored during the matches resulted from goal kicks, and in 5.7% of the matches the result of the match hinged on the outcome of a kick attempt. There was an extremely large decrease in success with increasing distance (odds ratio for two SD distance 0.06, 90% confidence interval 0.05-0.07) and a small decrease with increasingly acute angle away from the mid-line of the goal posts (odds ratio for 2 SD angle, 0.44, 0.39-0.49). Differences between players were typically small (odds ratio for 2 between-player SD 0.53, 0.45-0.65)., Conclusions: The generalized linear mixed model with its random-effect solutions provides a tool for ranking the performance of goal kickers in rugby. This modelling approach could be applied to other performance indicators in rugby and in other sports in which discrete outcomes are measured repeatedly on players or teams., (Copyright © 2015. Published by Elsevier Ltd.)

The physical preparation of team sport athletes should reflect the degree to which each component of fitness is relied upon in competition. The aim of the study was therefore to establish the relationship between fitness-test data and game behaviours known or thought to be important for successful play in rugby union matches. Fitness-test measures from 510 players were analysed with game statistics, from 296 games within the 2007 and 2008 calendar years. Sprint times over 10, 20 and 30 m had moderate to small negative correlations (r) with line breaks (~0.26), metres advanced (~0.22), tackle breaks (~0.16) and tries scored (~0.15). The average time of 12 repeated sprints and percentage body fat in the forwards, and repeated sprint fatigue in the backs had moderate to small correlations with a measure of activity rate on and around the ball (-0.38, -0.17 and -0.17, respectively). These low correlations are partly due to uniformly high physical fitness as a result of selection pressures at the elite level and leave room for the identification of other key predictors. Nonetheless, physical conditioning programmes should be adapted to reflect the importance of speed, repeated sprint ability and body composition in the performance of key game behaviours during competition.

Unlabelled: In rugby union, published analyses of actions and movements of players during matches have been limited to small samples of games at regional or national level., Objectives: To analyse movements and activities of players in international rugby union matches with a sample size sufficient to clearly delineate positional roles., Design: Observational study., Methods: Actions of 763 players were coded from video recordings of 90 international matches played by the New Zealand national team (the All Blacks) from 2004 to 2010. Movements of players were coded for 27 of these matches via a semi-automated player-tracking system. Movements and activities of all players from both teams were coded., Results: Cluster analysis of activities and time-motion variables produced five subgroups of forwards (props, hookers, locks, flankers, Number 8 forwards) and five subgroups of backs (scrum-half, fly-half, midfield backs, wings and fullbacks). Forwards sustained much higher contact loads per match than backs, via scrums, rucks, tackles and mauls. Mean distance covered per match ranged from 5400 to 6300m, with backs generally running further than forwards. There were marked differences between positional groups in the amount of distance covered at various speeds. The amount of play per match varies by position due to differences in rates at which players are substituted., Conclusions: The distance covered by players at relatively fast running speeds (in excess of 5ms(-1)) appears to be higher during international matches than when competing at lower levels of the professional game. The specific match demands for positional groups need to be considered when managing player workloads., (Copyright © 2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objective: In this study, the prevalence of abnormalities in the cervical spine of asymptomatic professional rugby players using both static and dynamic magnetic resonance imaging (MRI) in order to improve the detection of abnormalities and prevention of related injuries was investigated., Design: Prospective observational study., Setting: French professional rugby union clubs, between 2002 and 2006., Participants: 206 elite male adult players., Intervention: Static sagittal T2 and axial T2* fast spin echo (FSE), and dynamic sagittal single-shot FSE weighted MRI scans of the C2-C7 region were examined for the presence of abnormalities. Participants' spines were in supine neutral position for the static protocol but were allowed complete flexibility in a sagittal plane for the dynamic protocol., Main Outcome Measurements: The medulla-to-canal ratio (MCR) was measured at every vertebral disc level for both MRI methods. When observed, anatomical abnormalities were categorised., Results: Anatomical abnormalities mainly consisted of degenerative discopathy and were most frequently observed in players aged>21 years, as well as in players whose MCR was abnormally high based on medical expertise. Most MCRs that were initially assessed as intermediate with static MRI were subsequently assessed as abnormal with dynamic MRI assessment., Conclusions: Since dynamic MRI is more accurate than static techniques in examining the cervical spine, it contributes substantially to identifying the risk of spinal injuries in professional rugby players, and when used in association with clinical assessment, it can assist in preventing spinal injury.

RugbySmart, a rugby union injury prevention programme, was launched in New Zealand in 2001. It was compulsory for all coaches and referees to complete RugbySmart requirements annually in order to continue coaching or refereeing. After 5 years of implementation the programme partners, Accident Compensation Corporation and New Zealand Rugby Union, evaluated RugbySmart to determine its effectiveness in reducing injuries. The purpose was to evaluate the effect of RugbySmart on reducing injury rates per 100,000 players and resulting injury prevention behaviours. The RugbySmart programme was associated with a decrease in injury claims per 100,000 players in most areas the programme targeted; the programme had negligible impact on non-targeted injury sites. The decrease in injury claims numbers was supported by results from the player behaviour surveys pre- and post-RugbySmart. There was an increase in safe behaviour in the contact situations of tackle, scrum and ruck technique.

Background: The tackle is the most dangerous facet of play in rugby union, but little is known about risk factors for tackle injuries., Purpose: To estimate the injury risk associated with various characteristics of tackles in professional rugby union matches., Study Design: Descriptive epidemiology study., Method: All 140 249 tackles in 434 professional matches were coded from video recordings for height and direction of tackle on the ball carrier, speed of tackler, and speed of ball carrier; injuries were coded for various characteristics, including whether the tackler or ball carrier required replacement or only on-field assessment., Results: There were 1348 injury assessments requiring only on-field treatment and 211 requiring player replacement. The inciting event and medical outcomes were matched to video records for 281 injuries. Injuries were most frequently the result of high or middle tackles from the front or side, but rate of injury per tackle was higher for tackles from behind than from the front or side. Ball carriers were at highest risk from tackles to the head-neck region, whereas tacklers were most at risk when making low tackles. The impact of the tackle was the most common cause of injury, and the head was the most common site, but an important mechanism of lower limb injuries was loading with the weight of another player. Rates of replacement increased with increasing player speed., Conclusion: Strategies for reducing tackle injuries without radically changing the contact nature of the sport include further education of players about safe tackling and minor changes to laws for the height of the tackle.

Objective: To investigate the effect of RugbySmart, a nationwide educational injury prevention programme, on the frequency of spinal cord injuries., Design: Ecological study., Setting: New Zealand rugby union., Participants: Population at risk of injury comprised all New Zealand rugby union players., Intervention: From 2001, all New Zealand rugby coaches and referees have been required to complete RugbySmart, which focuses on educating rugby participants about physical conditioning, injury management, and safe techniques in the contact phases of rugby., Main Outcome Measures: Numbers of all spinal injuries due to participation in rugby union resulting in permanent disablement in 1976-2005, grouped into five year periods; observed compared with predicted number of spinal injuries in 2001-5., Results: Eight spinal injuries occurred in 2001-5, whereas the predicted number was 18.9 (relative rate=0.46, 95% confidence interval 0.19 to 1.14). Only one spinal injury resulted from scrums over the period; the predicted number was 9.0 (relative rate=0.11, 0.02 to 0.74). Corresponding observed and predicted rates for spinal injuries resulting from other phases of play (tackle, ruck, and maul) were 7 and 9.0 (relative rate=0.83, 0.29 to 2.36)., Conclusions: The introduction of the RugbySmart programme coincided with a reduction in the rate of disabling spinal injuries arising from scrums in rugby union. This study exemplifies the benefit of educational initiatives in injury prevention and the need for comprehensive injury surveillance systems for evaluating injury prevention initiatives in sport.

To illustrate changes in elite rugby union match activities, we analysed coded videotape recordings of the first match in each Bledisloe Cup series played between Australia and New Zealand from 1972 to 2004. We also analysed the stature and body mass of players. Effects associated with professionalism, weather conditions, and time (expressed as change per decade) were estimated with a simple generalized linear model and standardized for interpretation of magnitude. The sample size permitted confident conclusions about effects that were of at least moderate magnitude (standardized mean difference >0.6). Increases in passes, tackles, rucks, tries, and ball-in-play time were associated with the advent of professionalism, whereas there were reductions in the numbers of lineouts, mauls, kicks in play, and in mean participation time per player. Noteworthy time trends were an increase in the number of rucks and a decrease in the number of scrums. Good weather conditions were associated with increases in tries and points scored and with reductions in the number of kicks in play and participation time per player. With the advent of professionalism, players have become heavier and backs have become taller. Overall, there have been major changes in international rugby match activities and player size over the past three decades. We believe law changes and developments in match analysis, equipment technology, and player training have contributed to the changes associated with the introduction of professionalism.

Background: Risk factors for sports injuries include characteristics and behaviors of athletes and characteristics of sports and the environment that are associated with some measure of risk of injury., Objective: To introduce risk statistics to clinicians evaluating studies of sports injuries., Methods: Plain-language review of risk statistics and their practical application to sports injuries., Results: The various measures of injury incidence are injury risk (proportion of athletes injured in a given period of training, playing, or other exposure time), injury rate (number of injuries per unit of exposure time), odds of injury (probability injury will happen divided by probability injury will not happen), injury hazard (instantaneous proportion injured per unit of time or mean injury count per unit of time), and mean time or mean number of playing exposures to injury. Effects of risk factors are estimated as values of effect statistics representing differences or ratios of one or more of these measures between groups defined by the risk factor. Values of some ratios and their sampling uncertainty (confidence limits) are estimated with specialized procedures: odds ratios with logistic regression, rate ratios with Poisson regression, and hazard ratios with proportional hazards (Cox) regression. Injury risks and mean time to injury in each group can also be estimated and can give a better sense of the effect of a risk factor. Risk factors identified in nonexperimental cohort and case-control studies are not always causes of injury; data from randomized controlled trials provide stronger evidence of causality., Conclusion: Expressing risk statistics as meaningful numbers should help clinicians make better use of sports injury studies.

Background: Rugby union has a high rate of injury. The increased use of protective equipment may help mitigate these injuries. This study investigated the injury prevention effectiveness of the protective equipment used in rugby union., Methods: A cohort of 304 rugby players in Dunedin, New Zealand was followed weekly during the 1993 club season to assess protective equipment use, participation in rugby, and injury outcomes. Generalized Poisson regression was used to model the rate of injury while adjusting for covariates such as level of competition, playing position, and injury history., Results: The use of mouthguards appeared to lower the risk of orofacial injury [rate ratio (RR) = 0.56, 95% confidence interval (CI): 0.07-4.63], and padded headgear tended to prevent damage to the scalp and ears (RR = 0.59, 95% CI: 0.19-1.86). Support sleeves tended to reduce the risk of sprains and strains (RR = 0.58, 95% CI: 0.26-1.27). The risk of concussion was not lessened by the use of padded headgear (RR = 1.13, 95% CI: 0.40-3.16) or mouthguards (RR = 1.62, 95% CI: 0.51-5.11). There was no evidence of protective effects for any other equipment item (taping, shinguards, and grease)., Conclusions: The protective equipment used in rugby union has limited effectiveness in preventing injuries. The results are supportive, however, of a role for mouthguards and padded headgear in preventing orofacial and scalp injuries, respectively, and for support sleeves in preventing sprains and strains.

Injuries to the cervical spine are among the most serious injuries occurring as a result of participation in rugby. Outcomes of such injuries range from complete recovery to death, depending on the degree of spinal cord damage sustained. Much information has been gained regarding the mechanisms and frequency of such injuries, from case reports and case series studies. The most commonly reported mechanism of injury has been hyperflexion of the cervical spine, resulting in fracture dislocation of C4-C5 or C5-C6. Tracking both the trends of incidence of spinal injuries, and the effectiveness of injury prevention initiatives has proved difficult because of a lack of properly conducted epidemiological studies. Within the constraints of the research published to date, it appears that hookers and props have been at disproportionate risk of cervical spine injury, predominantly because of injuries sustained during scrummaging. While the scrum was the phase of play most commonly associated with spinal injuries throughout the 1980s in most rugby playing countries, there has been a trend through the 1990s of an increasing proportion of spinal injuries occurring in the tackle situation. The majority of injuries have occurred early in the season, when grounds tend to be harder, and players are lacking both practice and physical conditioning for the physical contact phases of the sport. A number of injury prevention measures have been launched, including changes to the laws of the game regarding scrummaging, and education programmes aimed at enforcing safe techniques and eliminating illegal play. Calls for case-registers and effective epidemiological studies have been made by researchers and physicians in most countries where rugby is widespread, but it appears to be only recently that definite steps have been made towards this goal. Well-designed epidemiological studies will be able to provide more accurate information about potential risk factors for injury such as age, grade, position, gender and ethnicity. Research into the long-term effects of participation in rugby on the integrity of the spinal column is warranted.

The aim of this study was to describe temporal patterns in the frequency, nature and circumstances of injuries occurring among a cohort of 356 rugby players during a club rugby season in New Zealand. It was found that the rate of injury in games decreased significantly over time in both males and females. The reduction in injury rate over the season was more pronounced in some grades, but no differences were found when examined by gender. playing position, age, ethnicity or by health and fitness types. Trends in injury rate were consistent over the rugby season and did not appear to be the result of a bias involving under-reporting of end-of-season injuries. The types and severity of injury remained relatively constant, but the proportion of injuries occurring in back play fell significantly over the season and injuries were more likely to occur in the trunk body region as the season progressed. This study supported the hypothesis that higher rates of injury occur at the start of the rugby season and decrease over the course of the season. This reduction is consistent over time and across player types, and is not attributable either to decreasing injury severity or to increasing player fitness.

In this study, we examined the relationship between anthropometric, strength and power characteristics of rugby forwards, their body position when scrummaging, and their ability to apply force when scrummaging. Force applied to an instrumented scrum machine was measured for 56 players, both individually and as scrum packs. Measurements of body position for individuals were made by digitizing videotape records of the trials. Forty players subsequently had their anthropometry assessed and completed several strength and power tests. Body mass, each component of somatotype, maximal anaerobic power developed on a cycle ergometer, and isokinetic knee extension strength correlated significantly with individual scrummaging force. A regression model (P < 0.001) including body mass, mesomorphy, maximal anaerobic power and hip angle while in the scrummaging position accounted for 45% of the variance in individual scrummaging force. The packs that produced the largest scrummaging forces were, in general, characterized by a greater pack force to sum of individual force ratio than the packs producing lower forces. Our results emphasize the need for a scrum pack to develop technique and coordination as a unit to maximize scrummaging force.

This study describes the nature and circumstances of injury occurring in rugby union tackles (33% of 569 injury events) using data from the Rugby Injury and Performance Project (RIPP) and provides supplementary information on the nature of tackles involving injury from analysis of videotape of tackle injury events. The most common tackle injuries in the RIPP data were sprains/strains (41%) followed by haematomas/bruising (26%). The most frequently injured body sites were the head/neck/face (22%) and the knee (17%). The ball carrier and tackler were injured in tackles in similar proportions in both RIPP and New Zealand Rugby Football Union (NZRFU) video tackle incidents. Both players were most often in motion in the tackle at the time of injury with approximately 70% of injuries occurring when the injured player was running or diving/falling to the ground. Tackle injury was most often caused by impact with another player rather than impact with the ground. The use of protective padding may reduce the risk of impact injury. The majority of tackle injuries were associated with stopping tackles to the trunk which were from the front (63%), rather than from the side or behind. Thus consideration should be given to coaching strategies or to rule changes which reduce the likelihood or prohibit front-on tackles.

Although heavy drinking has traditionally been associated with rugby, the drinking patterns of New Zealand rugby players have not been examined. Three hundred and forty-eight rugby players (257 males and 91 females), completed the Alcohol Use Disorders Identification Test (AUDIT) at the beginning of the 1993 rugby season. The mean AUDIT scores were 11.2 (SD = 5.1) for the males and 8.7 (4.1) for the females: a cut-off of 8.0 has been recommended by the developers of the instrument for identifying alcohol use disorders. The consumption of large quantities of alcohol, and a high frequency of heavy drinking sessions were the norm for this group. Sixty-one per cent of males and 38% of females consumed six or more drinks in a session at least weekly: typically, men drank 10 or more drinks in a session and women 5-6 drinks. The patterns of drinking exhibited by the cohort give cause for concern regarding the health risks associated with such behaviour.

Objective: To describe the anthropometric and physical performance characteristics of a sample of senior A club rugby players and to highlight differences between the positional categories of the players within the forwards and backs., Methods: 94 senior A male rugby players were assessed on a number of anthropometric and physical performance assessments. The forwards were categorised into props, hookers, locks, and loose forwards. Backs were categorised into inside, midfield, and outside backs. Categories within the forwards were compared with each other, as were the categories within the backs., Results: The anthropometric characteristics of forwards differed significantly between positional categories. Front row forwards (props and hookers) possessed highly endo-mesomorphic somatotypes, and typically rated very low for ectomorphy. Props possessed greater body mass than hookers. Locks and loose forwards were taller than the front row forwards. In terms of physical performance fewer differences were observed. Hookers performed better than props on an aerobic assessment. Locks and loose forwards were faster than the front row forwards on a 30 m sprint from a running start. The inside backs were shorter and lighter than the midfield and outside backs., Conclusions: The combination of anthropometric characteristics and physical performance attributes observed allows players to best meet the demands imposed on them by their position.

Objective: To investigate the anthropometric and physical performance characteristics of New Zealand rugby players of different ages and both sexes., Methods: 356 rugby players (264 male, 92 female) took part in the study during a single season. Playing grade ranged from schoolboys and schoolgirls to senior men and women. Assessment of height, weight, neck circumference, and somatotype was performed before the competitive rugby season. A battery of six physical performance assessments was completed after the anthropometry. Analysis of variance was used to examine differences in these variables between field positions and grades., Results: Significant differences between forwards and backs on anthropometric and physical performance variables were apparent at all grades assessed. In terms of anthropometric characteristics, forwards of a given grade were generally taller, possessed greater body mass, and were more endomorphic and less ectomorphic than backs of the same grade. The backs tended to perform better on physical performance measures than forwards, being more aerobically fit, faster, more agile, and possessing a higher degree of muscular endurance. Differences in anthropometry and physical performance attributes were also apparent between players from the various grades. The players at higher levels were generally larger, and performed better on tests of physical performance than the players at lower levels. These differences were found in both sexes., Conclusions: The greater body mass of the forwards allows them to obtain greater momentum than the backs when sprinting. The ability to obtain greater momentum is important in the body contact phases of the game. Forwards may compromise their aerobic fitness and speed to some extent in order to maintain a high body mass. The anthropometric and physical performance characteristics of players appear to reflect the demands placed on them by the sport.